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Gazel U, Ayan G, Hryciw N, Delorme JP, Hepworth E, Sampaio M, Jibri Z, Karsh J, Aydin SZ. Disease-specific definitions of new bone formation on spine radiographs: a systematic literature review. Rheumatol Adv Pract 2024; 8:rkae061. [PMID: 38827363 PMCID: PMC11142627 DOI: 10.1093/rap/rkae061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 03/24/2024] [Indexed: 06/04/2024] Open
Abstract
Objectives We aimed to explore the radiographic definitions of types of New Bone formation (NBF) by focusing on the terminology, description and location of the findings. Methods Three systematic literature reviews were conducted in parallel to identify the radiographic spinal NBF definitions for spondyloarthritis (SpA), Diffuse Idiopathic Skeletal Hyperostosis (DISH) and Osteorathritis (OA). Study characteristics and definitions were extracted independently by two reviewers. Definitions were analysed and collated based on whether they were unique, modified or established from previous research. Results We identified 33 studies that indicated a definition for the NBF in SpA, 10 for DISH and 7 for spinal OA. In SpA, the variations in syndesmophytes included the description as well as the subtypes and locations. The differentiation of syndesmophytes from osteophytes were included in 12 articles, based on the origin and the angle of the NBF and associated findings. The definitions of DISH varied in the number of vertebrae, level and laterality. For OA, five articles indicated that osteophytes arose from the anterior or lateral aspects of the vertebral bodies, and two studies required a size cut-off. Discussion Our ultimate aim is to create formal NBF definitions for SpA, DISH and OA guided by an atlas, through a Delphi exercise with international experts. The improved ability to differentiate these conditions radiographically will not only allow the clinicians to accurately approach patients but also will help the researchers to better classify patient phenotypes and focus on accurate radiographic outcomes.
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Affiliation(s)
- Ummugulsum Gazel
- Division of Rheumatology, Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada
| | - Gizem Ayan
- Division of Rheumatology, Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada
| | - Nicole Hryciw
- Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Jean-Philippe Delorme
- Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Elliot Hepworth
- Division of Rheumatology, Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada
| | - Marcos Sampaio
- Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
- Division of Radiology, Department of Medical Imaging, The Ottawa Hospital, Ottawa, ON, Canada
| | - Zaid Jibri
- Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
- Division of Radiology, Department of Medical Imaging, The Ottawa Hospital, Ottawa, ON, Canada
| | - Jacob Karsh
- Division of Rheumatology, Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Sibel Zehra Aydin
- Division of Rheumatology, Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
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Gnanasigamani JT, Ramalingam V. Inter-rater and Intra-rater Reliability of a Mobile App Method to Measure Lumbar Lordosis. Cureus 2024; 16:e55489. [PMID: 38571869 PMCID: PMC10988531 DOI: 10.7759/cureus.55489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 03/03/2024] [Indexed: 04/05/2024] Open
Abstract
Background Measuring the exact quantitative values of lordotic curves is a vital factor in clinical settings to prevent musculoskeletal deformities in the future. Existing lordotic assessment methods are very diverse, expensive, inaccurate, and not handy, and their availability cannot be maintained in every clinic setup. Aim The purpose of this research was to study the reliability of a mobile app as a feasible method to measure lumbar lordosis angle using a lateral view radiograph. Methodology A lateral view low back region radiograph of 58 participants was taken based on the criteria, and the experienced physiotherapists uploaded the X-ray to the mobile app and measured the lordotic angles with the support of machine learning algorithms. Descriptive statistics were used to calculate the average and dispersion of the data of the lumbar lordosis angle measured using the mobile app method (Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, IBM Corp., Version 23, Armonk, NY)). Results Associations between and within raters were assessed using the Karl Pearson coefficient of correlation (1.000). Inter-rater and intra-rater reliability were determined by using Cronbach's alpha (.966) and the split-half method. The internal consistency of the mobile app was found to be good. Conclusions Based on our findings, we conclude that the mobile app method is reliable and useful in measuring lumbar lordosis objectively with less effort. Since the app is handy on smartphones, physiotherapists can conduct an objective lumbar lordosis assessment in clinical settings.
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Affiliation(s)
- Jency Thangasheela Gnanasigamani
- Physiotherapy, Saveetha College of Physiotherapy, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Vinodhkumar Ramalingam
- Physiotherapy, Saveetha College of Physiotherapy, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
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Tekeli M, Erdem H, Kilic N, Boyan N, Oguz O, Soames RW. Evaluation of lumbar lordosis in symptomatic individuals and comparative analysis of six different techniques: a retrospective radiologic study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:4118-4127. [PMID: 37658171 DOI: 10.1007/s00586-023-07886-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 07/21/2023] [Accepted: 08/06/2023] [Indexed: 09/03/2023]
Abstract
PURPOSE The aim of this study; evaluate lumbar lordosis (LL) in symptomatic individuals with six different techniques and to examine the techniques comparatively. Thus, to provide an overview of lumbal lordosis and techniques. METHODS Cobb L1-L5, Cobb L1-S1, Posterior Tangent, tangential radiologic assessment of lumbar lordosis (TRALL), vertebral centroid measurement of lumbar lordosis (CLL) and Risser Ferguson measurement techniques were used to assess LL from radiographs of 175 symptomatic adults. Correlations between techniques and relationship between the measurements obtained, gender and age were analyzed. Also ınterclass correlation (ICC) analyzed. Bland-Altman plots were performed to compare the techniques with Cobb. RESULTS ICC for all methods were greater than 0.96. For each method, no difference in LL was observed with respect to gender or age (p > 0.05). High positive correlation was observed between the Risser Ferguson, Posterior Tangent, Cobb L1-L5, Cobb L1-S1 and CLL techniques (p < 0.001), and moderate positive correlation between TRALL and all other techniques (p < 0.001). CONCLUSION In this study, it was found that the mean lumbar lordosis values of symptomatic participants were lower than most of the other asymptomatic studies in the literature and there was no significant difference in lumbar lordosis values in terms of gender and age in symptomatic individuals. Based on statistical findings, Risser Ferguson can be used to assess LL. These results and the data obtained as a result of the comparative examination of techniques according to age groups and gender will benefit clinicians and those working in the field by providing a better understanding LL.
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Affiliation(s)
- Mustafa Tekeli
- Department of Anatomy, Faculty of Medicine, Nigde Omer Halisdemir University, Nigde, Turkey
| | - Huseyin Erdem
- Department of Anatomy, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Nazire Kilic
- Department of Anatomy, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Neslihan Boyan
- Department of Anatomy, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Ozkan Oguz
- Department of Anatomy, Faculty of Medicine, Cukurova University, Adana, Turkey.
| | - Roger W Soames
- Centre for Anatomy and Human Identification, School of Science and Engineering, University of Dundee, Dundee, UK
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Eddine HK, Saleh S, Hajjar J, Harati H, Nasser Z, Desoutter A, Al Ahmar E, Estephan E. Evaluation of the accuracy of new modalities in the assessment and classification of lumbar lordosis: A comparison to Cobb's angle measurement. Heliyon 2023; 9:e18952. [PMID: 37600414 PMCID: PMC10432978 DOI: 10.1016/j.heliyon.2023.e18952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 08/03/2023] [Accepted: 08/03/2023] [Indexed: 08/22/2023] Open
Abstract
Background Because of the association of lumbar lordosis with some clinical conditions such as low back pain, the chiropractic field has emphasized the significance of evaluating the lumbar lordotic status, by measuring Cobb's angle, regarded as the radiological gold standard, for the assessment of lumbar lordosis, on lateral radiographs. However, research has shown that this technique has some considerable drawbacks, mostly in terms of low accuracy and high variability between clinicians when compared with other radiological modalities. The main objective was to compare the diagnostic accuracy of newly established radiological measurements with one of Cobb's angle methods, for the characterization of lumbar lordosis status in a sample of Lebanese patients aged 15 and above. Material and methods This retrospective single-center study consisted of measuring Cobb's L1-S1 and Cobb's L1-L5 angles, along with the novel established measurements which are the derivative and the normalized surface area, on 134 lateral radiographs of the lumbar spine of Lebanese patients aged fifteen years old and above, gotten from the Radiology department at Zahra'a's Hospital in Beirut, performed by two observers using MATLAB. Inter-rater agreement was assessed by calculating the Intra-class correlation coefficients. Spearman correlation was analyzed between both Cobb's angle methods and with the derivative and normalized area respectively. 54 patients of the sample were diagnosed by two radiologists, according to their LL status. ROC curve analysis was performed to compare the diagnostic accuracy of the four techniques used. Data were analyzed with IBM SPSS Statistics 23.0 (NY, USA); P < 0.05 was considered statistically significant. Results According to the ROC curve analysis the new methods, which are the derivative and the normalized surface area, displayed lower diagnostic accuracy (AUCderivative = 0.818 and 0.677, AUCsurface area = 0.796 and 0.828) than Cobb's L1-L5 (AUCL1-L5 = 0.924 and 0.929 values) and L1-S1 (AUCL1-S1 = 0.971 and 0.955) angles, in the characterization of hypo and hyperlordotic patients, respectively, in our Lebanese sample consisting of patients aged 15 and above, because of their lower area under the curve's values compared to the traditional Cobb's techniques. The Cobb's L1-S1 has shown to have the highest diagnostic accuracy among the four methods to characterize normal patients from hypo and hyperlordotic ones, by referring to its highest area under the curve's values. However, the sensitivity of Cobb's L1-L5 angle in characterizing hyperlordotic patients was similar to the one of the normalized surface area with a value of 100%.Conclusion: among the four modalities, the new methods didn't show a better diagnostic accuracy compared to the traditional modalities. Cobb's L1-S1 displayed the highest diagnostic accuracy despite its drawbacks. Further prospective studies are needed to validate the cut-offs obtained for Cobb's L1-S1 angle in our sample.
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Affiliation(s)
- Hassane Kheir Eddine
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Sahera Saleh
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Joseph Hajjar
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Hayat Harati
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Zeina Nasser
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | | | - Elie Al Ahmar
- School of Engineering, Holy Spirit University of Kaslik, Jounieh, Lebanon
- Faculty of Arts and Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon
| | - Elias Estephan
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
- LBN, University Montpellier, Montpellier, France
- Faculty of Arts and Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon
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Okpala FO. Age-of-cessation of lumbar lordosis development as an assessment parameter. Afr J Paediatr Surg 2022; 19:203-208. [PMID: 36018198 PMCID: PMC9615960 DOI: 10.4103/ajps.ajps_109_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND In managing paediatric spinal deformities, the currently-in-use growth maturity assessment parameters (clinical or radiological) are based mostly on Caucasian populations. They may be adequate for general treatment planning but may not accurately predict the remaining growth potential. Some therapies (e.g. growing rod distractions or growth modulation surgeries) require more accurate predictions of remaining growth potential and race-specific values. Lumbar lordosis (LL) development ceases at spinal bone maturity. The age-of-cessation seems a more accurate predictor of remaining spinal bone growth potential, compared to currently-in-use growth maturity assessment parameters, but is rarely included in the growth maturity assessment parameters. AIMS AND OBJECTIVES As a predictor of remaining spinal growth potential, age-of-cessation of LL development (Race-specific of Black populations) was quantified. MATERIALS AND METHODS In archival normal lateral lumbosacral radiographs of patients of a tertiary hospital in South-East Nigeria, LL development across five age groups (Birth- 9, 10-15, 16-20, 21-25 and 26-30 years) was quantified with lumbosacral joint angle (LSJA) in 215 (110 males, 105 females), and lumbosacral angle (LSA) in 238 (119 males, 119 females). Data were analysed with IBM SPSS Statistics 23.0 (NY, USA). P ≤ 0.05 was considered statistically significant. RESULTS Both LSJA and LSA age groups' mean values progressively increased with age, and plateaued at 21-25 years range, with LSJA mean of 23.4 ± 1.3 years, and LSA mean 23.5 ± 1.3 years; the means difference was insignificant (P = 0.680). CONCLUSION With ageing, there is progressive increment, and later, cessation of LL. Age-of-cessation indirectly infers spinal-maturity-age, and could indirectly be an assessment parameter of spinal-maturity-status.
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Affiliation(s)
- Francis Osita Okpala
- Department of Radiology, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
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Lakkadsha TM, Qureshi MI, Kovela RK, Saifee SS, Lalwani SS. Efficacy of Single Stretching Session of Iliopsoas Using Proprioceptive Neuromuscular Facilitation Versus Muscle Energy Technique on Low Back Pain in Patients With Lumbar Hyper-Lordosis. Cureus 2022; 14:e27916. [PMID: 36110466 PMCID: PMC9464355 DOI: 10.7759/cureus.27916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 08/12/2022] [Indexed: 12/02/2022] Open
Abstract
Background and objectives One of the most frequent conditions for which people seek physiotherapy treatment is low back pain (LBP). When the aetiology of low back pain is whittled down to mechanical factors, pelvic tilting becomes apparent. The iliopsoas muscle is the key to relieving LBP in such circumstances, and since it is tightened, we concentrated on stretching it adequately in this study. Proprioceptive neuromuscular facilitation (PNF) and muscle energy technique (MET) are two stretching techniques that we have compared for this purpose. There are many other stretching techniques available, but the evidence has proven these two to be the most effective. Methods The participants in the study were those between the ages of 18 and 60 who had exaggerated lumbar lordosis, or LBP, and met the inclusion criteria. There were two groups created: A and B. PNF and traditional physiotherapy was used to manage the participants in group A, and MET and traditional physiotherapy were used to manage the participants in group B. Each group underwent the same pre-and post-tests, which included the Numerical Pain Rating Scale (NPRS) to assess pain intensity; a universal goniometer to measure hip joint extension range of motion (ROM) to assess iliopsoas flexibility; and a side-lying X-ray to measure the lumbosacral angle (LSA) to determine the angle of lumbar lordosis. Result In both the stretching interventions, i.e., PNF and MET, there were statistically significant differences in pain, hip extension range of motion, and lumbar lordosis angle (P > 0.0001). However, for the PNF group, the difference between the pre-and post-test was greater than that for the MET group. Conclusion The current study, which included 100 participants, demonstrated that both PNF and MET are remarkably effective for loosening the tight iliopsoas. A comparison of both techniques showed that the PNF group had benefited significantly more than the MET group.
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Fan X, Mirza SK, Li C, Evans LT, Ji S, Paulsen KD. Accuracy of Stereovision-Updated Versus Preoperative CT-Based Image Guidance in Multilevel Lumbar Pedicle Screw Placement: A Cadaveric Swine Study. JB JS Open Access 2022; 7:JBJSOA-D-21-00129. [PMID: 35350121 PMCID: PMC8937011 DOI: 10.2106/jbjs.oa.21.00129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Change in vertebral position between preoperative imaging and the surgical procedure reduces the accuracy of image-guided spinal surgery, requiring repeated imaging and surgical field registration, a process that takes time and exposes patients to additional radiation. We developed a handheld, camera-based, deformable registration system (intraoperative stereovision, iSV) to register the surgical field automatically and compensate for spinal motion during surgery without further radiation exposure. Methods We measured motion-induced errors in image-guided lumbar pedicle screw placement in 6 whole-pig cadavers using state-of-the-art commercial spine navigation (StealthStation; Medtronic) and iSV registration that compensates for intraoperative vertebral motion. We induced spinal motion by using preoperative computed tomography (pCT) of the lumbar spine performed in the supine position with accentuated lordosis and performing surgery with the animal in the prone position. StealthStation registration of pCT occurred using metallic fiducial markers implanted in each vertebra, and iSV data were acquired to perform a deformable registration between pCT and the surgical field. Sixty-eight pedicle screws were placed in 6 whole-pig cadavers using iSV and StealthStation registrations in random order of vertebral level, relying only on image guidance without invoking the surgeon's judgment. The position of each pedicle screw was assessed with post-procedure CT and confirmed via anatomical dissection. Registration errors were assessed on the basis of implanted fiducials. Results The frequency and severity of pedicle screw perforation were lower for iSV registration compared with StealthStation (97% versus 68% with Grade 0 medial perforation for iSV and StealthStation, respectively). Severe perforation occurred only with StealthStation (18% versus 0% for iSV). The overall time required for iSV registration (computational efficiency) was ∼10 to 15 minutes and was comparable with StealthStation registration (∼10 min). The mean target registration error was smaller for iSV relative to StealthStation (2.81 ± 0.91 versus 8.37 ± 1.76 mm). Conclusions Pedicle screw placement was more accurate with iSV registration compared with state-of-the-art commercial navigation based on preoperative CT when alignment of the spine changed during surgery. Clinical Relevance The iSV system compensated for intervertebral motion, which obviated the need for repeated vertebral registration while providing efficient, accurate, radiation-free navigation during open spinal surgery.
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Affiliation(s)
- Xiaoyao Fan
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire
| | - Sohail K. Mirza
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire,PEERClinic for Back Pain and Spine Surgery, Fairfax, Virginia
| | - Chen Li
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire
| | - Linton T. Evans
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire,Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Songbai Ji
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire,Department of Biomedical Engineering, Worcester Polytechnic Institute, Worcester, Massachusetts
| | - Keith D. Paulsen
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire,Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire,Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
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Balboni JM, Siddique K, Nomoto EK, Wong AP, Yashar P, Hill PS, Smith R, Perri K, Perri BR. Novel use of robotics and navigation for anterior lumbar total disc replacement surgery. NORTH AMERICAN SPINE SOCIETY JOURNAL (NASSJ) 2022; 9:100097. [PMID: 35141661 PMCID: PMC8820011 DOI: 10.1016/j.xnsj.2021.100097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/02/2021] [Accepted: 12/17/2021] [Indexed: 11/26/2022]
Abstract
The ability to navigate the anterior lumbar disc space may improve clinical outcomes and implant longevity. However, no robotic navigation systems are presently authorized by the U.S. Food and Drug Administration to assist with anterior retroperitoneal lumbar interbody surgery. Furthermore, no studies to date have investigated such an application of this technology. This study examines the application of robotic navigation to anterior lumbar total disc replacement surgery to improve retroperitoneal exposure and orientation of the anterior lumbar spine, enhance coronal plane centralization of the implant, optimize surgical trajectory, and mitigate radiologic exposure. Postoperative outcomes of a small cohort of patients undergoing anterior lumbar total disc replacement surgery using robotic navigation were analyzed. The results of the study revealed that a modified use of the aforementioned robot-assisted surgical technology enhances coronal plane centralization and trajectory, all while mitigating radiologic exposure, resulting in more accurate placement of the implant within the intervertebral space at each level.
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Deep Learning based Vertebral Body Segmentation with Extraction of Spinal Measurements and Disorder Disease Classification. Biomed Signal Process Control 2022. [DOI: 10.1016/j.bspc.2021.103230] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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10
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Noorollah J. Lordosis: a force for good - a plea for terminology guidelines on spinal alignment. Spine J 2021; 21:1773-1774. [PMID: 34051362 DOI: 10.1016/j.spinee.2021.05.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 05/19/2021] [Accepted: 05/21/2021] [Indexed: 02/03/2023]
Affiliation(s)
- Javid Noorollah
- Cass Regional Medical Center, Rock Haven Medical Mall, 2820 Rock Haven Rd, Suite 170, Harrisonville, MO 64701, USA.
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11
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Jang SW, Yang HS, Kim YB, Yang JC, Kang KB, Kim TW, Park KH, Jeon KS, Shin HD, Kim YE, Cho HN, Lee YK, Lee Y, Lee SBN, Ahn DY, Sim WS, Jo M, Jo GJ, Park DB, Park GS. Comparison of the Effectiveness of Three Lumbosacral Orthoses on Early Spine Surgery Patients: A Prospective Cohort Study. Ann Rehabil Med 2021; 45:24-32. [PMID: 33557479 PMCID: PMC7960949 DOI: 10.5535/arm.20158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective To compare the convenience and effectiveness of the existing lumbosacral orthoses (LSO) (classic LSO and Cybertech) and a newly developed LSO (V-LSO) by analyzing postoperative data. Methods This prospective cohort study was performed from May 2019 to November 2019 and enrolled and analyzed 88 patients with degenerative lumbar spine disease scheduled for elective lumbar surgery. Three types of LSO that were provided according to the time of patient registration were applied for 6 weeks. Patients were randomized into the classic LSO group (n=31), Cybertech group (n=26), and V-LSO group (n=31). All patients were assessed using the Oswestry Disability Index (ODI) preoperatively and underwent plain lumbar radiography (anteroposterior and lateral views) 10 days postoperatively. Lumbar lordosis (LS angle) and frontal imbalance were measured with and without LSO. At the sixth postoperative week, a follow-up assessment with the ODI and orthosis questionnaire was conducted. Results No significant differences were found among the three groups in terms of the LS angle, frontal imbalance, ODI, and orthosis questionnaire results. When the change in the LS angle and frontal imbalance toward the reference value was defined as a positive change with and without LSO, the rate of positive change was significantly different in the V-LSO group (LS angle: 41.94% vs. 61.54% vs. 83.87%; p=0.003). Conclusion The newly developed LSO showed no difference regarding its effectiveness and compliance when compared with the existing LSO, but it was more effective in correcting lumbar lordosis.
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Affiliation(s)
- Soo Woong Jang
- Department of Rehabilitation Medicine, Veterans Health Service Medical Center, Seoul, Korea
| | - Hee Seung Yang
- Department of Rehabilitation Medicine, Veterans Health Service Medical Center, Seoul, Korea
| | - Young Bae Kim
- Department of Orthopedic Surgery, Veterans Health Service Medical Center, Seoul, Korea
| | - Joo Chul Yang
- Department of Neurosurgery, Veterans Health Service Medical Center, Seoul, Korea
| | - Kyu Bok Kang
- Department of Orthopedic Surgery, Veterans Health Service Medical Center, Seoul, Korea
| | - Tae Wan Kim
- Department of Neurosurgery, Veterans Health Service Medical Center, Seoul, Korea
| | - Kwan Ho Park
- Department of Neurosurgery, Veterans Health Service Medical Center, Seoul, Korea
| | - Kyung Soo Jeon
- Department of Rehabilitation Medicine, Veterans Health Service Medical Center, Seoul, Korea
| | - Hee Dong Shin
- Department of Rehabilitation Medicine, Veterans Health Service Medical Center, Seoul, Korea
| | - Ye Eun Kim
- Department of Neurosurgery, Veterans Health Service Medical Center, Seoul, Korea
| | - Han Na Cho
- Department of Orthopedic Surgery, Veterans Health Service Medical Center, Seoul, Korea
| | - Yun Kyung Lee
- Department of Rehabilitation Medicine, Veterans Health Service Medical Center, Seoul, Korea
| | - Young Lee
- Veterans Medical Research Institute, Veterans Health Service Medical Center, Seoul, Korea
| | - Seul Bin Na Lee
- Veterans Medical Research Institute, Veterans Health Service Medical Center, Seoul, Korea
| | - Dong Young Ahn
- Center of Prosthetics and Orthotics, Veterans Health Service Medical Center, Seoul, Korea
| | - Woo Sob Sim
- Center of Prosthetics and Orthotics, Veterans Health Service Medical Center, Seoul, Korea
| | - Min Jo
- Center of Prosthetics and Orthotics, Veterans Health Service Medical Center, Seoul, Korea
| | - Gyu Jik Jo
- Center of Prosthetics and Orthotics, Veterans Health Service Medical Center, Seoul, Korea
| | - Dong Bum Park
- Center of Prosthetics and Orthotics, Veterans Health Service Medical Center, Seoul, Korea
| | - Gwan Su Park
- Center of Prosthetics and Orthotics, Veterans Health Service Medical Center, Seoul, Korea
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Veerbeek BE, Lamberts RP, Fieggen AG, Mankahla N, de Villiers RVP, Botha E, Langerak NG. A long-term follow-up study of spinal abnormalities and pain in adults with cerebral palsy and spastic diplegia more than 25 years after selective dorsal rhizotomy. J Neurosurg Spine 2020; 34:228-235. [PMID: 33065536 DOI: 10.3171/2020.6.spine20751] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 06/09/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The main purpose of selective dorsal rhizotomy (SDR) is to reduce spasticity in the lower extremities of children diagnosed with cerebral palsy (CP) and spastic diplegia. The potential for developing spinal abnormalities and pain is a concern, especially in the aging CP population. Therefore, the aim of this study was to evaluate spinal abnormalities, level of pain, and disability (due to back or leg pain) in adults with CP, and associations with participant characteristics, more than 25 years after SDR. METHODS This is a 9-year follow-up study with data collection conducted in 2008 and 2017. Radiographs were assessed for the degree of scoliosis, thoracic kyphosis and lumbar lordosis curvatures, and prevalence of spondylolysis and spondylolisthesis, while level of pain and disability was determined with a self-developed questionnaire and the Oswestry Disability Index (ODI) questionnaire, respectively. RESULTS Twenty-five participants were included (15 males; median age 35.9 years, IQR 34.3-41.5 years), with a follow-up time after SDR ranging from 25 to 35 years. No clinically relevant changes were found for spinal curvatures, spondylolysis and spondylolisthesis, perceived pain frequency, and ODI scores between 2008 and 2017. While the prevalence of spondylolysis was 44%, spondylolisthesis was found in 20% (of whom 15% were grade I and 5% grade II), lumbar hyperlordosis was found in 32%, thoracic hyperkyphosis in 4%, and scoliosis in 20%. The Cobb angle was < 25°, and no patient required surgery for scoliosis. In addition, the low back was reported as the most common site of pain, with 28% of the adults with CP having daily pain. This resulted in 80% of the cohort indicating none or minimal disability due to pain based on the ODI. The only correlation found was between hyperkyphosis and female gender. CONCLUSIONS At follow-up more than 25 years after SDR, no progression in spinal abnormalities, level of pain, and disability was found when compared with findings 15 years after SDR. The prevalence of scoliosis, thoracic hyperkyphosis, and lumbar hyperlordosis was within the range reported for adults with CP, while spondylolysis and spondylolisthesis occurred more often than would be expected. It is difficult, however, to establish the role of SDR in this finding, given the limited data on the natural history of CP. Despite the encouraging outcome of this long-term follow-up study after SDR, it is important to continue monitoring adults with CP during the aging process.
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Affiliation(s)
- Berendina E Veerbeek
- 1Department of Surgery, Division of Neurosurgery and Neuroscience Institute, University of Cape Town
| | - Robert P Lamberts
- 2Department of Surgical Sciences, Division of Orthopaedic Surgery, Stellenbosch University, Cape Town; and
| | - A Graham Fieggen
- 1Department of Surgery, Division of Neurosurgery and Neuroscience Institute, University of Cape Town
| | - Ncedile Mankahla
- 1Department of Surgery, Division of Neurosurgery and Neuroscience Institute, University of Cape Town
| | - Richard V P de Villiers
- 3Winelands Radiology, Institute of Orthopaedics and Rheumatology, Winelands Orthopaedic Hospital, Stellenbosch, Western Cape, South Africa
| | - Elsabe Botha
- 3Winelands Radiology, Institute of Orthopaedics and Rheumatology, Winelands Orthopaedic Hospital, Stellenbosch, Western Cape, South Africa
| | - Nelleke G Langerak
- 1Department of Surgery, Division of Neurosurgery and Neuroscience Institute, University of Cape Town
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Russell BS, Muhlenkamp-Wermert KA, Hoiriis KT. Measurement of Lumbar Lordosis: A Comparison of 2 Alternatives to the Cobb Angle. J Manipulative Physiol Ther 2020; 43:760-767. [PMID: 32888701 DOI: 10.1016/j.jmpt.2020.05.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 04/10/2020] [Accepted: 05/17/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The purpose of this study was to compare 2 alternative methods, the radiologic Harrison Posterior Tangent Method (HPTM) and the nonradiologic Spinal Mouse (SM), to the Cobb angle for measuring lumbar lordosis. METHODS Sixteen participants with previously existing lateral lumbopelvic radiographs underwent nonradiographic lordosis assessment with a Spinal Mouse. Then 2 investigators analyzed each radiograph twice using the Harrison Posterior Tangent Method and Cobb angle. Correlations were analyzed between HPTM, the Cobb angle, and SM using the Spearman rank correlation coefficient; intraexaminer and interexaminer agreement were analyzed for HPTM and the Cobb angle using intraclass correlation coefficients. RESULTS The HPTM correlated highly with the Cobb angle (Spearman ρ = 0.936, P < .001); SM had moderate to strong correlations with the Cobb angle (ρ = 0.737, P = .002) and HPTM (ρ = 0.707, P = .003). Intraexaminer and interexaminer agreement for the Cobb angle and HPTM were excellent (all intraclass correlation coefficients > 0.90). One participant had slight kyphosis according to HPTM and SM analyses (which consider the entire lumbar region), whereas the Cobb angle, based only on L1 and L5, reported mild lordosis for that participant. CONCLUSION In this sample, HPTM measurements showed high correlation with the commonly used Cobb angle, but this method requires more time and effort, and normal values have not been established. The SM may be an alternative when radiographs are inappropriate, but it measures soft tissue contours rather than lordosis itself.
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Affiliation(s)
- Brent S Russell
- Dr. Sid E. Williams Center for Chiropractic Research, Life University, Marietta, Georgia.
| | | | - Kathryn T Hoiriis
- Dr. Sid E. Williams Center for Chiropractic Research, Life University, Marietta, Georgia
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14
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Yang G, Li Y, Zhang H. The Influence of Pelvic Tilt on the Anteversion Angle of the Acetabular Prosthesis. Orthop Surg 2020; 11:762-769. [PMID: 31663281 PMCID: PMC6819173 DOI: 10.1111/os.12543] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 08/24/2019] [Accepted: 08/28/2019] [Indexed: 12/23/2022] Open
Abstract
The concept of the "safe area" of the acetabular prosthesis has a long history and has been recognized by many scholars. It is generally believed that postoperative hip dislocation rate is low, when the acetabular anteversion angle is placed in the range of 15° ± 10°. Despite this, hip dislocation is a common complication after total hip arthroplasty. In recent years, more and more scholars have paid attention to the influence of pelvic tilt on the acetabular anteversion angle. The concept of acetabular anteversion changes as the pelvic tilt changes, and is challenging the traditional acetabular prosthesis "safe area." This study summarized the potential influencing factors of pelvic tilt and discussed the influence of the phenomenon on the anteversion angle of total hip arthroplasty (THA) acetabular prosthesis based on the literature review. We conclude that from the supine position to standing, followed by sitting, the pelvis tends to move backward. Pelvic sagittal activity, lumbar disease (ankylosing spondylitis), lumbar fusion (lumbar fusion, spine-pelvic fusion), and other factors related to the tilt are THA risk factors for postoperative dislocation and revision. With the change of body position, the degree of acetabular anteversion is directly related to the degree of pelvic tilt. The acetabular anteversion varies greatly, which leads to increased hip prosthesis wear and even hip dislocation. The lateral X-ray of the spine and pelvis is recommended in supine, standing, and sitting positions before THA. In addition, the pelvic tilt should be regarded as a reference of the acetabular prosthesis in the preoperative planning of THA.
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Affiliation(s)
- Guoyue Yang
- Orthopaedic Department, Third Central Hospital of Tianjin, Tianjin, China.,Tianjin Institute of Hepatobiliary Disease, Tianjin, China.,Tianjin Key Laboratory of Artificial Cell, Tianjin, China.,Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin, China
| | - Yayue Li
- Orthopaedic Department, Third Central Hospital of Tianjin, Tianjin, China.,Tianjin Institute of Hepatobiliary Disease, Tianjin, China.,Tianjin Key Laboratory of Artificial Cell, Tianjin, China.,Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin, China
| | - Hong Zhang
- Orthopaedic Department, The Fourth Medical Center of the Chinese People's Liberation Army General Hospital, Beijing, China
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Wu Z, Zhu Y, Xu W, Liang J, Guan Y, Xu X. Analysis of Biomechanical Properties of the Lumbar Extensor Myofascia in Elderly Patients with Chronic Low Back Pain and That in Healthy People. BIOMED RESEARCH INTERNATIONAL 2020; 2020:7649157. [PMID: 32149135 PMCID: PMC7049445 DOI: 10.1155/2020/7649157] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 10/04/2019] [Accepted: 01/09/2020] [Indexed: 11/17/2022]
Abstract
There is limited research on the changes of biomechanical characteristics of the lumbar extensor myofascia in elderly patients with chronic low back pain. This study aimed to compare the biomechanical properties of the lumbar extensor myofascia in elderly patients with chronic low back pain and healthy people when resting and to analyze the relationship between the Japanese Orthopedic Association (JOA) score, visual analog scale (VAS) score, Cobb angle, and disease course and the biomechanical characteristics of the lumbar extensor myofascia. This case-control study included 40 elderly patients with chronic low back pain and 40 healthy volunteers. MyotonPRO was used to measure the biomechanical properties of the bilateral lumbar extensor myofascia (at L3/L4 level) in all participants, and the reliability of the MyotonPRO test was measured. Cobb angle was measured from lumbar computed tomography or magnetic resonance imaging data. JOA and VAS scores were used to evaluate lumbar function and pain. We found that muscle tone, stiffness, and elasticity of the left and right lumbar extensor myofascia in patients with chronic low back pain were very reliable among different operators. The average lumbar extensor muscle tone and stiffness were significantly higher in patients with chronic low back pain than those in healthy controls. The average elasticity of the lumbar extensor myofascia of patients with chronic low back pain was significantly lower than that of the healthy controls. The JOA score was negatively correlated, while the VAS score was positively correlated with the mean values of tone, stiffness, and elasticity of the bilateral lumbar extensor myofascia (logarithmic decrement). Disease course had no significant correlation with muscle tone, stiffness, and elasticity of the lumbar extensor myofascia. No significant correlation was found between Cobb angle and muscle tone, stiffness, and elasticity of the lumbar extensor myofascia in either group.
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Affiliation(s)
- Zugui Wu
- The Fifth Clinical College of Guangzhou University of Chinese Medicine, Guangzhou 510000, China
| | - Yue Zhu
- Baishui Town Health Center, Zhanyi District, Qujing 655000, China
| | - Wu Xu
- Guangdong Provincial Second Hospital of Traditional Chinese Medicine, Guangzhou 510000, China
| | - Junquan Liang
- Guangzhou University of Chinese Medicine, Guangzhou 510000, China
| | - Yingxin Guan
- The Fifth Clinical College of Guangzhou University of Chinese Medicine, Guangzhou 510000, China
| | - Xuemeng Xu
- Guangdong Provincial Second Hospital of Traditional Chinese Medicine, Guangzhou 510000, China
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